{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T17:43:39Z","timestamp":1761932619179,"version":"build-2065373602"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Musculoskeletal disorders (MSDs) represent a global primary cause of disability, affecting over 1.69 billion individuals and accounting for over 160 million disability-adjusted life years (DALYs) in 2021. Conventional metrics assess care quality inadequately, necessitating a multidimensional evaluation framework. Thus, this study introduces a novel metric \u2014 the Quality of Care Index (QCI) \u2014 to comprehensively evaluate the MSD landscape.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop a novel QCI for MSDs and evaluate global trends, disparities, and drivers from 1990 to 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using Global Burden of Disease (GBD) 2021 data across 204 countries, we constructed a composite QCI integrating four domains: Pain Relief Rate(PRR), Opioid Use Rate(OUR), Need-Independent Coverage(NIC), and Patient Satisfaction(PS). These were standardized into a single index using Principal Component Analysis (PCA). Trends were analyzed via Estimated Annual Percentage Change (EAPC), with disparities assessed by Socio-Demographic Index (SDI) and geography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significant increases in MSDs prevalence (over 12.7% of low back pain; near doubling of osteoarthritis) and DALYs occurred globally, driven by aging populations. Geographic Paradox: Lower- and middle-income countries (LMICs; e.g., Vanuatu, Nicaragua, Central African Republic) achieved higher QCI scores than high-income nations (e.g., Italy, Germany, Japan). QCI improved in LMICs (notably for osteoarthritis\/neck pain) but stagnated or even declined in high-income regions. DALYs correlated positively with SDI (R\u2009=\u20090.649\u20130.863; p\u2009&lt;\u20090.001), with steepest rises in middle- and high-SDI areas for low back pain and osteoarthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The QCI scores reveal critical relationship between MSDs burden and care quality. High-income regions experience challenges of opioid overuse and stagnant patient satisfaction, while LMICs express gains in access and perceived relief. Implementing context-stratified strategies \u2014 de-implementing low-value care in high-SDI areas while scaling evidence-based access in resource-constrained regions \u2014 constitutes a critical pathway to equitably alleviate the global MSDs burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0335235","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T17:32:20Z","timestamp":1761931940000},"page":"e0335235","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Global assessment of pain care quality for musculoskeletal disorders: Insights from the quality of care index (QCI) from 1990 to 2021"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5928-2346","authenticated-orcid":true,"given":"Zhicong","family":"Xia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiangguang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xia","family":"Wen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"pone.0335235.ref001","doi-asserted-by":"crossref","first-page":"3455","DOI":"10.2147\/JPR.S488133","article-title":"From Pain to Progress: Comprehensive Analysis of Musculoskeletal Disorders Worldwide","volume":"17","author":"J Zhou","year":"2024","journal-title":"J Pain 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